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[Jeepers]

Hi

Has anyone experienced spotting when changing taking utrogestan from orally to vaginally please?

Thank you

Jeepers

[Sid]

Hi Jeepers

It was the other way round for me.  I had spotting and early bleeds when I took the Utrogestan orally.  When I started using it vaginally the problems stopped.  I don't seem to absorb it well orally 

[Jeepers]

Thanks for your reply.


Just shows we are all different doesn't it?

A very kind person has told me that its common if you take it alternative nights.
This is what's recommend on Dr Newsons website.  Maybe I'll just go for every night then?

Thanks

Jeepers x

[Traceylr]

hi there Jeepers,
I switched from oral to vaginal and had spotting for a few weeks . Been taking the utro vaginally ( 100mg ie one capsule) every night , for nearly three years no problems, no side effects. But if I  get very highly stressed or miss a couple the spotting can return , but this has only happened once. Had a uterine scan and all was well. Hope it suits you taking it this way as well as it does me .

[Jeepers]

Thanks Tracey, that's very reassuring

 Jeepers x

[Jeepers]

My spotting has now turned into a proper bleed, with some mild cramping,

 

Jeepers x

[Hurdity]

Thanks for your reply.


Just shows we are all different doesn't it?

A very kind person has told me that its common if you take it alternative nights.
This is what's recommend on Dr Newsons website.  Maybe I'll just go for every night then?

Thanks

Jeepers x

Hi Jeepers in fact Dr Newson's website says the following:

https://www.menopausedoctor.co.uk/menopause/micronised-progesterone-or-utrogestan

"Some women use the progesterone vaginally rather than taking it orally, which can be associated with less side effects. Evidence has shown that using 100mg progesterone vaginally alternate evenings as a continuous (no bleed) preparation or 100mg progesterone vaginally every evening for 12-14 days each month as a cyclical (leading to periods) preparation is safe.

Many women use the oral Utrogestan capsules vaginally ...... Progesterone is not licensed to be used in this way but there is evidence to support that this is safe. Women who use it in this way should seek individualised advice from their doctor."

Therefore it is important not to change prescription on the basis of what someone says - eg if you started off by doing this (alternate day regime) orally because it would not be sufficient for most women.

I have posted the information on vaginal Utrogestan studies on this thread: https://www.menopausematters.co.uk/forum/index.php/topic,43633.msg696198.html#msg696198. The studies using vaginal alternate ( and in one study twice weekly) were using low to medium doses of oestrogen, and studies have been small, so the statement is probably not universally applicable although this review has put the regime as one of its recommendations for off-licence use:

The impact of micronized progesterone on breast cancer risk: a systematic review https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1421925 "(2) vaginal micronized progesterone may provide endometrial protection if applied sequentially for at least 10 days/month at 4% (45 mg/day) or every other day at 100 mg/day for up to 3-5 years (off-label use);" . Note use of the word "MAY" !!

Sorry I can't remember where you are in menopause and what regime you have been using for how long? The fact you are bleeding means either you are still peri or that the oral regime was not sufficient and your womb lining has built up a bit on this regime, so switching to the (more efficient) vaginal route is allowing the prog to do its work. If you are post-meno - eventually the progesterone should prevent the lining from buolding up so that you don't bleed ( provided no womb problems eg fibroids etc).

As always if you are worried about the bleeding then do consult your doctor - but the above is one explanation.

All the best

Hurdity x

[Jeepers]

Hi hurdity

Thank you for your detailed reply. I am 4 years post Meno, and have been on hrt for about 18 months.

Maybe I should get a scan to check. I had a scan and hysteroscopy in march or April of last year, which showed a thin atrophic endometrium, so it's a bit shocking to think it may have built up.

The flow is not heavy, and only a liner needed to contain it, but more than spotting.

I'll get in touch with the clinic

Thanks again

Jeepers x

[Hurdity]

Hi again Jeepers - you didn't say what dose of oestrogen you are taking as this would give more of an indication also of the cause of the spotting. eg if you were on 25 mcg low dose patch then potentially still could be atrophied? I gave that reply because you said it had turned into a proper bleed with cramping but if you say it is just a bit more than spotting then at this point there is nothing to be alarmed about and especially if you are not on a high dose of oestrogen? All in all - it would be wise to get checked out again to be on the safe side - and perhaps ask the doc if you can be referred for a scan but please don't be worried! Remember bleeding and spotting on HRT is to be expected at various time depending on the balance of oestrogen and prog, and it is post-menopausal bleeding when you're not taking HRT that is more of a cause for concern.

Take care.

Hurdity x

[Jeepers]

Sorry if I am not being very clear, I'm not even sure myself. The bleeding I'd getting more as time moves along, probably like a light period now, the blood is bright red, although it started out quite dark.

I am on 2.5 pumps of oestrogel, I was on 3 but have recently reduced. I've also now gone back to oral utrogestan every night, to see if it helps.

I'm still waiting for the Meno clinic to get back to me, so I really appreciate your input.

Jeepers x

[Hurdity]

Hi Jeepers - OK. Well if you're absorbing the oestrogen then the bleeding sounds most likely to be because the progesterone dose you have been taking is insufficient to protect the endometrium - if you have been taking it orally every other day since May/June. Like I said this is not recommended by anyone evebn specialists! However no need to panic - if you've gone back to taking it orally then yes it's important to take it daily but still have that check-up just to see if the lining is too thick. If it has thickened and no other issues then you may still get some bleeding and spotting until it thins down again.

Let us know the outcome as well as what the meno clinic says!?

Hurdity x

[Jeepers]

Hi Hurdity

I had my scan today, and the lining was 3.3mm, which is more than last year  - 2.8, but still within range I think. Ovaries also okay , small simple cyst, but I think I've had that a few years, no one seems bothered.

So,  I've reverted to Utrogestan every night orally, and I think I?ll stick there for now.  I also had bloods taken to check oestrogen levels

Thank you all for all the support you've given me

Jeepers xx

[Hurdity]

Hi Jeepers

So pleased to hear all was well and thanks for updating us. I am somewhat puzzled as to the bleeding though - if your lining is so thin. It would be unlikely due to endometrial atrophy with that dose of gel I would suggest? Maybe just that the oral alternate day dose is not sufficient to stabilise the lining even though it is not thickening?

Anyway - great news and I hope you can relax a bit now

Hurdity x

[Washington]

Hi, I am a bit late to the party but hope you can help! I am post meno for 18 months and started vaginal utrogestan (couldn't tolerate orally) in December 2021. I also use two pumps of Oestrogel (one morning and one evening). Since starting utrogestan internally I have started spotting intermittently with some mild cramping. Not sure if this is to be expected and will settle down? Many thanks

[sheila99]

Sme bleeding can be expected in the first 6 months of a new conti regime. Other than this any post menopausal bleeding should be investigated. Is it possible you have VA and it's from irritation?